Helping trusts understand the impact of coding practice in relation to readmissions and the impact on income

Jeanette Sephton - Managing Consultant, CHKS

Jeanette has been with CHKS since 2007 and works with clients in the north west.

What was the focus of your work?

A trust in the north west was reporting an increasing rate of readmissions within 30 days, mainly in the medical division. The trust was keen to understand whether the readmissions were due to poor quality of care, e.g. missed diagnosis in the original spell. It was also important to investigate the impact of the penalty imposed under the payment by results (PbR) rules for readmissions.  

Was there a specific piece of work you contributed to?

Any patients who were readmitted and then died, were identified and included on the trust’s mortality review group. A review was undertaken of each case to determine if poor-quality care in the original spell contributed to the readmission and subsequent death of that patient.

How did you use your experience and expertise?

Having reviewed readmissions at other trusts, we found that rates of readmission are often affected by increased short stay admissions to the clinical decisions unit (CDU). Although admission to CDU supports the four-hour wait target, the impact can often be overlooked.  In addition, trusts often benchmark themselves according to readmission rates and then use this to reassure themselves that there is no cause for concern if they are lower than a clinical peer, or the national average. Bringing the focus back to the number of patients who are readmitted and identifying the reasons for readmission also provides vital clinical governance assurance.  

What did you find?

Analysis revealed an increasing number of emergency zero length of stay cases during the relevant period. If a patient is transferred from accident and emergency to a clinical decision unit they have to be admitted, even if they go home that day. This creates an extra spell that has shown to increase the likelihood of emergency readmission within 28 days, which will then incur a penalty under the payment by results rules. Further analysis also revealed that patients who were coming back on a chemotherapy cycle were being incorrectly categorised as an emergency admission instead of a booked/planned admission. The regular attendance of these cases was contributing to the rising readmission rate.

Extracting the analysis and filtering out those that would impose a penalty, enabled the trust to understand the impact on income and focus on any patterns that would warrant further investigation.

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